To send kids to school without vaccinations, parents in Ontario must first attend a class of their own.

Conducted one-on-one or in groups as large as 50 at their local health units, the mandatory “vaccine education” sessions for parents pursuing exemptions consists mainly of a video screening, with a nurse on hand to answer any questions. The 25-minute government-prescribed film features a cheery musical soundtrack, footage of smiling families and animated characters — kids playing soccer, dogs, a rainbow — along with information to counter popular myths among “anti-vaxxers.”

But since it was introduced in 2017, thousands of mothers and fathers have dutifully watched the video, collected their “Vaccine Education Certificate” — then continued to duck the shots.

As one public health manager put it: “We had a zero percent conversion rate.”

Parents found it insulting to have the government force them to be 're-educated'

That’s not only a colossal waste of time and money, some health policy experts say, but the education sessions may actually entrench resistance among parents claiming exemptions based on religious belief or “conscience.”

With the resurgence of dreaded, entirely preventable illnesses like measles and whooping cough, there are renewed calls for compulsory shots, not only for school-aged children but for babies and toddlers as well, with no waivers or opt-outs except for medical reasons.

Right now, only Ontario and New Brunswick require any proof of immunization for school attendance. But both provinces allow nonmedical exemptions, and in Ontario they are rising: Among seven-year-olds registered for school in 2012-2013, philosophical and religious objections accounted for 89 per cent of all exemptions.

Until recently, parents dodging vaccines in Ontario were simply required to submit a sworn affidavit stating their objections. The bar was raised slightly with the amendment of the Immunization of School Pupils Act to require attendance at exemption classes.

The video featured at such sessions debunks the junk science spread by celebrities, as well as defrocked doctors such as Britain’s Andrew Wakefield, whose 1998 study in The Lancet linking the measles, mumps and rubella vaccine with autism will go down as one of the most breathtakingly fraudulent papers in modern medicine.

But Ontario’s chief medical officer of health, Dr. David Williams, says the goal isn’t to scare, berate or coerce parents. It’s to make sure those who object to one or more designated shots are fully informed of what they’re risking. “We’re trying to give them what they need to know so they can make a good decision,” he said — the good decision, of course, being to vaccinate their children.

Instead, according to a National Post survey of the province’s 35 health units, the majority of parents double down after vaccine education sessions, a phenomenon known as “confirmation bias.” Any new information tends to be interpreted in a way that supports what they already believe.

Of 314 parents who attended an education session between September 2017 and December 2018 at the Ottawa Public Health unit, for example, only one did not go on to submit a formal exemption form.

In Hamilton, 398 parents have received their “education certificate” since September 2017. “We are aware of only one parent who has changed their mind after the education session,” reports a city communications officer, Aisling Higgins.

At the Huron County Health Unit, “It has been our experience that generally parents who attend the vaccine education session continue to seek an exemption afterwards,” said spokeswoman Rita Marshall.

In Toronto, meanwhile, a survey of 105 parents who received vaccination education in 2017-2018 found that 79 per cent were still not intending to have their children inoculated, 13 per cent said they were unsure, and only eight per cent said they would no longer seek an exemption.

That same school year, 4,572 out of 272,808 Toronto students were registered with a philosophical objection. That’s slightly higher than previous years.

Not all of Ontario’s health units are tracking how many parents continue to seek exemptions after sitting through an educational video. Some declined to comment at all, referring the Post to the ministry of health — which referred us back to the health units.

The video itself certainly covers vaccine basics — what’s in them and how they work. It explains how vaccines beat both smallpox (which disfigured and killed millions of children before it was declared eradicated in 1980) and polio (11,000 Canadians paralyzed between 1949 and 1954). It makes clear that homeopathic vaccines, or “nosodes,” watery, massively diluted solutions that have never been proven to prevent infection, are no substitute for real vaccines, no matter how they’re marketed. And it refutes the autism myth perpetrated by Wakefield’s since-retracted paper.

But unlike Oregon’s vaccine education video, for example, there are no pictures of toddlers with life-threatening swelling of the neck (bull neck) from diphtheria, no audio of what a baby with whooping cough sounds like as she struggles to breath through the thick secretions accumulating in her lungs. Nor are there any dramatic local narratives like that of the six-year-old Oregon boy who, unvaccinated for tetanus, went into spasms and spent 47 days in intensive care after cutting his forehead while playing on a farm, his hospital bills totaling US$811,929.

Avoiding a more graphic approach may be a mistake. As Paul Offit, the head of the Vaccine Education Center at the Children’s Hospital of Philadelphia, put it in a recent piece in Science Magazine, “I think we are compelled by fear more than reason. You have to make parents realize that their choice isn’t a risk-free choice.”

Others, however, have found a “danger-priming” effect. One large 2014 study found that dramatic narratives and pictures of sick children increased misperceptions about the MMR vaccine. Some parents were even confused about the images they were shown of children with measles. They thought they showed the side effects of the vaccines.

To members of Vaccine Choice Canada, a group that believes measles is a “benign and beneficial illness” and that all the fuss over the recent outbreak in Vancouver is artificially hyped hysteria, Ontario’s education sessions are a “joke,” misleading, patronizing and inaccurate. (The content is based on peer-reviewed science.)

“Parents stated that they have already extensively researched the topic of vaccine safety and effectiveness and that they found it insulting to have the government force them to be ‘re-educated,’” says vice-president Ted Kuntz, who, at the request of the Post, put out a question to parents on the organization’s social media platforms.

That’s hardly surprising, says Brian Koberlein, a senior lecturer of physics and a science communicator at the Rochester Institute of Technology. “In general, when you learn a misconception, it’s difficult to let go of it,” he says. And a brief class isn’t going to suddenly win people over. It’s more like detention after school.

“Good parents don’t put their children in harms way,” Koberlein says. “So, if you believe that vaccines are harmful, the thought of vaccinating your child can make you feel angry or scared. It’s hard to dispel those emotions in a single presentation.” Still, the effort may not be entirely futile, “because the more you hear the facts the better the chance that they will stick with you,” he says.

But Ubaka Ogbogu, a professor of health law at the University of Alberta, disagrees. In his view, vaccination education is a pointless waste of resources. “Education is a tool that should be used in conjunction with a policy that focuses on the best interests of the child,” he says, and that means mandatory vaccinations — “sans” any religious or conscientious objections.

In the U.S., three states — Mississippi, West Virginia and California — have done away with religious and personal belief exemptions for public school students. In Mississippi, the state or deputy state epidemiologist reviews even medical exemptions. Today, the state has the highest vaccination rate in the U.S.

In Canada, immunization rates are sub-optimal. A 2013 UNICEF report on uptake rates ranked Canada 28th out of 29 high-income countries. A study two years later found that only 89 per cent of two year-olds in Canada were vaccinated against measles, mumps and rubella; only 77 per cent received the four recommended doses for diphtheria, pertussis and tetanus. The target for both vaccines is 95 per cent.

While anti-vaxxers and the “vaccine-hesitant” remain in the minority, nonmedical exemptions have doubled since 1985. Given enough of them, exemptions can seriously undermine herd immunity. Children who are not vaccinated are 35 times more likely to contract measles. They also put kids who cannot be vaccinated — those with cancer, heart or lung diseases, allergies or compromised immune systems — at risk.

The science, as Ogbogu and others point out, is unimpeachable. Vaccination saves lives. “But there is a lack of bravery or even political will to do what’s necessary,” he says. “It boggles my mind.”

Ogbogu believes children should be vaccinated at the earliest age safety allows.

If a parent fails to do so, he says, temporary guardianship could be awarded to a non-objecting family member or to child welfare authorities until the child can be vaccinated and returned home.

“All you need is one province to take the lead, and, if the vaccination rate starts to improve, others may follow. Imagine if all the money wasted on this education program in Ontario was used to enforce a mandatory policy?”

But Dr. Joan Robinson, a pediatric infectious disease specialist at the University of Alberta, isn’t convinced. In a debate with Ogbogu published in Alberta Views last month, she argues that sheer logistics are one obvious problem with compulsory vaccination: About 0.5 per cent of parents in the province are firmly anti-immunization, she writes, and there are 50,000 births each year; that would mean 250 babies would need apprehension, likely not just for their first shot but all five necessary for full inoculation.

More than this, Robinson told the Post, it’s not a very Canadian approach: “It doesn’t feel like something that fits with the way our society functions.” She also questions whether the courts would allow it. In 2014, an Ontario judge ruled that an 11-year-old aboriginal girl’s family had a constitutional right to pull her out of chemotherapy and treat her leukemia with traditional native and alternative remedies instead. She later died of her cancer.

“If they won’t apprehend to save a life are they going to apprehend for an immunization to prevent an infection the child may never be exposed to?” Robinson says.

A better way to improve vaccination rates, she argues, is to make the shots more convenient for working parents, and to teach children earlier about the history of scourges like small pox and polio “so that when they become adults they know the evidence that is out there.”

A number of countries have compulsory vaccination laws, however, among them Bulgaria, Croatia, the Czech Republic, France, Greece, Latvia, Hungary, Poland and Slovakia. This week, Italy began to enforce a law banning unvaccinated children from school.

Ogbogu believes mandatory shots would survive a Charter challenge in Canada, for two reasons: First, it would likely be viewed as a reasonable limit on a parent’s right to freedom of religion and conscience, and it’s the rights of the child that are at stake; secondly, no protected right that parents enjoy is violated by a mandatory vaccination rule.

A recent poll by Angus Reid also suggests the vast majority of Canadians would be entirely comfortable with compulsory shots for any child attending daycare or school who can safely be immunized. About 70 per cent of respondents across the country agreed with the statement, “vaccinations should be mandatory.”

California dropped nonmedical exemptions only after the 2015 measles outbreak at Disneyland — we shouldn’t wait for an emergency, says Ogbogu. As he points out, once there is a disease outbreak even parents opposed to vaccines tend to immunize their children. Vaccination rates went up at two Vancouver schools after the recent measles outbreak.

“You hold out and then you get the disease in the community and then you panic and do the right thing? That makes no sense to me.”

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